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Orchard Cottage
Good

Reports

Inspection carried out on 17 April 2019

During a routine inspection

About the service:

Orchard Cottage provides accommodation with personal care to older people, some of whom may be living with dementia. The accommodation is provided over two floors and care is provided for up to 10 people. There were 8 people using the service when we inspected.

People’s experience of using this service:

People told us they felt safe with staff. Comments included, “Yes, I am safe here” and “We are well looked after, it is our home.”

People had good relationships with staff, who were knowledgeable of their physical and emotional needs, as well as likes, dislikes and interests. Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

People felt included in planning their care. Care plans were person centred, achieved good outcomes and showed people were offered choice and involved wherever possible.

People’s rights, their dignity and privacy were respected. One relative said, “The staff are very good, we see the same regular staff and are always welcome.”

Staff supported people to maintain a balanced diet and monitor their nutritional health.

Medicines were stored and managed safely by staff and the registered manager. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People received care from staff who were well supported with induction, training and ongoing supervision.

People knew how to complain and that any concerns would be listened and responded to by the provider. Actions were taken as a response to complaints as appropriate.

Feedback from people and relatives was sought and used to make improvements.

The provider had made changes to improve the service for people. On-going redecoration was planned over the next twelve months.

Quality monitoring systems included audits, checks on staff practice and checks on people's satisfaction with the service they received.

The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

Lessons were learnt and used to make improvements.

The service was led by an experienced, competent manager who understood their role and responsibilities, as did staff. The service had a clear management structure and people had confidence in the manager and provider.

Rating at last inspection: The service was rated as Requires Improvement at the last comprehensive inspection on 24 August 2016. Subsequently a focussed inspection was carried out on 02 March 2017, showing improvements had been made and the Safe domain was rated as Good.

At this inspection, the service met the characteristics of Good in all domains.

Why we inspected: This was a comprehensive inspection scheduled based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of Orchard Cottage on 24 August 2016 at which we found a breach of regulation. At this inspection, we found that people had not always received safe and appropriate care. The registered provider did not deploy sufficient numbers of staff to ensure that people's needs were always met.

Due to our concerns and the breach of regulation, we issued a requirement notice where the provider and the registered manager were required to take action to ensure they met with our regulation.

We undertook a focused inspection on 7 March 2017 to check that the service now met the legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Orchard Cottage’ on our website at www.cqc.org.uk.

Orchard Cottage is a residential care home that provides accommodation and support for up to 10 older people. Nine people were using the service at the time of our inspection on 7 March 2017.

At our focused inspection on 7 March 2017, we found the registered manager and provider met the legal requirements in relation to staffing. There were sufficient numbers staff deployed to enable them to support people safely and to complete their duties in an unhurried manner. People’s requests for support were attended to without delay. Staffing levels were reviewed and increased where appropriate to meet people’s needs. The duty rotas consistently and adequately covered routine shifts and planned absences to ensure there were sufficient staff to meet people’s needs safely and appropriately.

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During a routine inspection

This unannounced inspection took place on 24 August 2016. The service was last inspected on December 2013 and met all regulations we reviewed.

Orchard Cottage provides accommodation and support with personal care for 10 older people. At the time of the inspection there were nine people at the service. One person was on holiday.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are “registered persons”. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although some people and their relatives felt that there were enough staff at the service, we found that the level of staff available was not always sufficient to ensure people’s assessed needs were met. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

Risk assessments had been completed for people and staff were aware of the actions they needed to take to reduce risks to people. People and their relatives told us the staff were kind and they could trust them. We noted staff knew what adult safeguarding meant and the procedures to follow to record and report any incidents of abuse.

People had their medicines administered by staff who had relevant experience and training. Staff and records showed that new staff were checked properly before their employment to ensure they had the knowledge and experience needed to support people who used the service. We noted staff had the opportunity to attend training relevant to their roles including the Mental Capacity Act 2005.

The service had a homely feeling with people being able to access communal areas. People and their relatives told us staff were caring. We observed staff giving people plenty of time to listen to and chat with them. People told us staff treated them with respect and ensured their privacy. Records showed people had access to health care and were provided with food that reflected their preferences.

Although some activities were provided at the service, we noted that these were not available when and as people wanted. We also noted that the shower on the ground floor was not ready and safe to use. We have made a recommendation for the provider to make improvements. Overall we found the service was well managed with an effective staff team.

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During a routine inspection

People who used the service could be confident that their consent would be sort before any care or treatment was given. We found that before people received any care they were asked for their consent and that the provider had procedures in place that would ensure they acted in accordance with legal requirements.

People’s needs were assessed, and care and treatment was planned and delivered in line with their individual care plan to protect people’s welfare.

People told us that staff looked after them well, that they were always treated with respect, that the food was good. People told us that they felt the home provided safe care.

People who used the service and staff we talked with told us that there was enough staff to meet people’s needs. We observed that the staff on shift during our inspection were meeting people’s needs and delivering care and support in a timely manner.

People who used the service were asked for their views about their care and treatment and they were acted on. The provider told us that they gained regular informal feedback from people who used the service.

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During a routine inspection

As part of our inspection we spoke with five people who used the service about the care and support they received. We also spoke with the Registered Manager and four support staff. During the inspection we saw that there was a friendly and relaxed atmosphere and staff supported people in a kind and positive way.

People we spoke with told us that they liked living at the home and felt safe. Comments included "It's very nice here", "I wouldn't want to leave" and "I have no concerns".

People spoke highly of the staff and described them as "Caring" and "Lovely". People told us that they were happy with the care provided and said they were well looked after. During our inspection we saw that staff spoke to people in a respectful and caring way.

All of the people we spoke with said they liked the food and could choose to have something different if they didn't like what was on the menu. One person said "The food is very good" and "I'm always asked what I like".

We found that the home was warm and people looked comfortable. Staff told us that the equipment used in the home was in "Good working order" and they felt "Confident" using it.

Staff told us they felt "Supported" by their manager but would like staff meetings to be held regularly.

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During a routine inspection

People said they liked living at Orchard House. They said they had visited the home before admission and been involved in discussions about the help they needed and their preferred day to day routines. People said there were different activities to do and that they could join in with activities if they wanted to. They said they were happy with the support they received, that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. They said that the home was always kept clean and smelled fresh. People said they knew who to speak to should they have any concerns.

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.